mobility and musculoskeletal Flashcards

Question

ask questions of recent weight gain and pain

Answer 1

Why are they here? Recent weight gain? Weight gain can increase physical stress and strain Pain or tenderness? Bone pain can be dull/deep Joint or muscle pain can be aching

Answer 2

When did it start? What does the pain feel like? Sharp, stabbing, aching Was there an injury? Fractures increased pain with movement and usually sharp pain

Answer 3

Use of corticosteroids causes decreased bone density.

Answer 4

Joint stiffening can occur in tetanus/polio

Answer 5

Diabetes, lupus, osteoporosis

Answer 6

Menopause? (For middle aged women) – decreased estrogen levels lead to decrease bone density = increased risk of osteoporosis

Answer 7

Activity level? Activity promotes health of MS system Medications? Some medications can alter MS function diuretics-alter electrolytes = muscle weakness steroids – deplete bone mass,

Answer 8

Smoking /alcohol use? Smoking and alcohol use risk of osteoporosis Occupation, Leisure activities, ADL’s, stress

Answer 9

Gait is the first assessment completed for a musculoskeletal assessment assess for risk of falling – always protect the patient Observe posture standing with feet together and sitting – is weight evenly distributed? Do they have abnormal curvature? observe gait – is weight evenly distributed? Are movements coordinated?

Answer 10

Inspect and palpate the TMJ – place index and middle fingers anterior to the ear opening. Ask client to open and close mouth. Fingers should drop into open space. Test range of motion - open and close mouth / bite down Grating or crepitus can signal TMJ dysfunction Assess for difficulty chewing – is grating or crepitus noted

Answer 11

look for swelling, masses Palpate for tenderness

Answer 12

– Observe the cervical, thoracic, lumbar curves. – Palpate the spinous processes and paravertebral muscles for tenderness or pain. – Test ROM of the cervical, thoracic, lumbar spine. – Test for back and leg pain.

Answer 13

lasegues test Lay patient flat on their back and raise one leg up with knee straight. If patient experiences sciatic pain when leg is lifted there is a suspicion for a herniated lumbar disc.

Answer 14

Impaired ROM and neck pain with fever/chills/headache can indicated meningitis! This is a serious and often lethal infection!

Answer 15

Palpate by placing index and middle finger just anterior to the external ear opening, client opens mouth wide – ROM: Client able to move jaw laterally against resistance. Clenching teeth causes contraction of the temporal and masseter muscles (no pain or spasms should be present) – TMJ dysfunction: pain in the jaw joint and muscles that control jaw movement * Clicking sound or grating sensation when mouth open or chewing

Answer 16

– inspection – symmetry, color, swelling – Palpate – tenderness or masses – ROM – abduction, adduction, flexion and extension, internal and external rotation

Answer 17

– Inspect for size, shape, deformities, redness, or swelling. – Test ROM. – flexion / extension / supination / pronation

Answer 18

* Inspection – shape, symmetry, color, swelling * Palpate – tenderness in wrist or fingers * ROM – flexion (bend wrist down) /extension (bend wrist up) / spread fingers apart * Swelling can indicate rheumatoid arthritis * Non-tender round mass may be a ganglion cyst

Answer 19

– Place back of hands together while flexing wrists 90 degrees and fingers pointed downward. Hold for 60 seconds. * No numbness or tingling = normal * Tingling, numbness, burning = carpal tunnel is suspected

Answer 20

Use your finger to lightly percuss over the median nerve (inner aspect of the wrist). Tingling of shocking sensation is + sign for carpal tunnel syndrome. This test has a high false-positive rate.

Answer 21

* Flexion & Extension * Abduction & adduction * Opposition

Answer 22

Do not test ROM in a patient that has had a hip replacement!!!!! – inspection- buttock symmetry, hips appear stable – Palpate- non- tender without crepitus (grating, cracking or popping sound) – ROM and strength

Answer 23

– Inspection – size, shape, symmetry * Swelling near patella may indicate fluid in the joint – Palpate – tenderness, masses, swelling * If swelling present, perform the bulge test (with client supine use the ball of your hand to stroke medial side of knee upward 3-4 times to displace any accumulated fluid. Next, on the lateral side of the knee and look for a bulge on the medial side. + bulge = joint effusion (fluid) * Tenderness and warmth may indicate synovitis (inflammation of synovial membrane) – ROM – flexion, extension, walking

Answer 24

– Inspect position, alignment, shape, and skin. – Palpate ankles and feet for tenderness, heat, swelling, or nodules. – Test ROM. Dorsiflexion, Plantar flexion, Inversion, Eversion, Abduction, Adduction

Answer 25

* Carotid * Brachial * Radial * Ulnar-may be difficult to palpate * Femoral * Popliteal -may be difficult to palpate * Posterior Tibial * Dorsalis Pedis

Answer 26

pain, pulse, parasthesia, pallor, pain

Answer 27

* Kyphosis – rounded thoracic * Lumbar lordosis – over rounding lumbar * Scoliosis – curvature of spine

Answer 28

* Acute rheumatoid arthritis – tender, painful, swollen, stiff joints * Pain may be described as burning or throbbing which worsens with long periods of sitting/rest * Burning or throbbing on BOTH sides of the body * Stiffness in the joints that persists for at least an hour * Chronic rheumatoid arthritis – chronic swelling and thickening of phalangeal joints, limited ROM and finger deviation

Answer 29

* A CHRONIC disease in the joints * Decreased ROM, swelling, tenderness or crepitus may be seen * Pain usually occurs with one set of joints on ONE side of the body- pain is “deep in the joint” * Pain improves with rest and worsens in rain (perhaps a sensation of bones grating together), stiffness early in the morning that improves with movement * Decreased muscles strength

Answer 30

* One in three women and one in five men will have a fractured bone, with hip, forearm, and vertebral fractures predominating. * Osteoporosis is lowest in black males and highest in white females. * Smoking puts patients at higher risk of osteoporosis! * Medications can put patients at higher risk of fractures – Corticosteroids (prednisone, cortisone) – Cancer medications (methotrexate) – Diuretics (Furosemide) – Antacids that contain aluminum

Answer 31

Uncontrollable risk factors: – Age, gender, family history, previous fracture, ethnicity, menopause/hysterectomy – Caucasian women are a high-risk group for osteoporosis! Modifiable risk factors: – Alcohol, smoking, low body mass index, poor nutrition, vitamin D deficiency, eating disorders, low dietary calcium intake, insufficient exercise (sedentary lifestyle), frequent falls

Answer 32

1 Ensure a nutritious diet with adequate calcium intake. 2 Avoid protein malnutrition and undernutritio n. 3 Maintain an adequate supply of vitamin D. 4 Participate in regular physical activity. 5 Avoid the effects of second-hand smoke.

Answer 33

great toe is tender, painful, swollen, red and hot

Answer 34

non-painful, thickened skin

Answer 35

painful thickened skin over bony prominences / pressure points

Answer 36

painful thickened skin over bony prominences / pressure points

Answer 37

* Older clients usually have slower movements, reduced flexibility, and decreased muscle strength because of age-related muscle fiber and joint degeneration, reduced elasticity of the tendons, and joint capsule calcification. * An exaggerated thoracic curve (kyphosis) is common with aging. * Bones lose their density with age, putting the older client at risk for bone fractures, especially of the wrists, hips, and vertebrae. * Joint-stiffening conditions may be misdiagnosed as arthritis, especially in the older adult. * Osteoporosis is more common as a person ages because bone resorption increases, calcium absorption decreases, and production of osteoblasts decreases as well. * Some older clients have an impaired sense of position in space, which may contribute to the risks of falling.

Answer 38

* Realignment of spinal curve due to increase in size of uterus. This gives the patient a “waddling gait”. * Increased mobility of the pelvic joints to allow for stretching. – Gynecoid pelvis * Stretched and weakened muscles of the back and abdomen. * Center of gravity shifts forward. * Results in increased back and pelvic pain as well as an increase in risk of falling.

Answer 39

flex infant’s knees and abduct legs moving knees outward and down – clicking signifies possible hip dysplasia (femur slipping in and out).

Answer 40

flex infants knees and adduct legs – feeling of head of femur slipping is positive sign of hip dysplasia

Answer 41

incomplete closing of the neural tube, of the spinal cord. Defect can range from minor to severe disability.

Answer 42

The spine has a single C-shaped curve in infants under 3 months old.

Answer 43

knock knees

Answer 44

bowed legs

Answer 45

Observe gait as the child enters the room. * Rapid bone growth in infancy and adolescence * Bones increase in circumference and length under the influence of hormones * Muscle Growth is related to the growth of the underlying bone * This age group is suspectable to trauma/musculoskeletal injury * Genu varum (bowed legs) * Genu Valgum (knock knees) * “toeing in” or “toeing out” indicates such problems as tibial torsion or club foot * Inadequate muscle size and strength for the particular age may indicate neuromuscular disorder (ie. Muscular dystrophy)

Answer 46

School screenings for scoliosis are usually completed between the ages of 10-14. This is done by having the client bend forward at the waist and assessing the curvature of the spine

Answer 47

* Monitor for frequent fractures, as this may be a sign of abuse or a disorder of the Musculoskeletal system * Provide appropriate client teaching about safety and protective gear (i.e., sports gear) * School screenings for scoliosis are usually completed between the ages of 10-14. This is done by having the client bend forward at the waist and assessing the curvature of the spine * Proper nutrition is necessary for healthy growth and development * Childhood obesity is a serious problem in the U.S. and is associated with significant health risks * It is important to educate parents as well as children & adolescents on proper nutrition and calorie intake – A balanced diet * Adolescents is an important time when milk (calcium) and protein are needed to aid in bone and muscle growth – Common dietary deficiencies include iron, folate and zinc * Play, activity and exercise patterns can give the nurse valuable clues about a child’s overall health and allows the examiner to provide health promotion teaching